|Número de publicación||US7527633 B2|
|Tipo de publicación||Concesión|
|Número de solicitud||US 09/874,302|
|Fecha de publicación||5 May 2009|
|Fecha de presentación||5 Jun 2001|
|Fecha de prioridad||5 Jun 2000|
|También publicado como||CA2409391A1, CA2409391C, DE60117977D1, EP1289429A2, EP1289429B1, EP1665991A2, EP1665991A3, EP1665991A9, US7927342, US8808312, US8858575, US20010053916, US20050085831, US20090209994, US20110213388, US20120330094, WO2001093656A2, WO2001093656A3|
|Número de publicación||09874302, 874302, US 7527633 B2, US 7527633B2, US-B2-7527633, US7527633 B2, US7527633B2|
|Inventores||Robert F. Rioux|
|Cesionario original||Boston Scientific Scimed Inc.|
|Exportar cita||BiBTeX, EndNote, RefMan|
|Citas de patentes (115), Otras citas (43), Citada por (21), Clasificaciones (16), Eventos legales (3)|
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet|
This application claims the priority to and the benefit of U.S. provisional patent application Ser. No. 60/209,234 filed on Jun. 5, 2000, which is incorporated herein by reference in its entirety.
This invention relates to methods and devices for the treatment of female urinary incontinence.
Stress urinary incontinence in women may be caused by urethral hypermobility. Hypermobility is a condition in which the pelvic floor fails to properly support an area between the bladder neck and mid-urethra, thus permitting the urethra to descend from its normal anatomic position in response to increases in intra-abdominal pressure, resulting in urinary incontinence.
Surgical procedures for stabilizing the urethra include suburethral slings and needle suspensions. In some sling procedures, a suburethral sling is placed around the posterior side of the urethra and the ends are attached to an anatomical support structure, for example, the Cooper's ligament, or the abdominal fascia. In some variations, however, a suburethral sling may be placed around the posterior side of the urethra with the ends left free, that is, the ends of the sling are not attached to an anatomical structure. In needle suspension methods, the urethra is suspended by fastening periurethral tissue to anatomical support structures using sutures. In one variation of both the suburethral sling and the needle suspension procedures, the sling or suture is attached to the pubic bone by a bone anchor or surgical staple. The introduction of such foreign objects into bone, however, presents a risk of bone marrow infection and/or pubic osteitis. Furthermore, drilling holes into the pubic bone and/or driving a bone anchor into the pubic bone is contraindicated for patients with osteoporosis. The common goal of suburetheral sling and bladder neck suspension procedures is to return the poorly supported, hypermobile urethra to its normal retropubic position.
Suburethral sling procedures and needle suspension procedures involve cutting through vaginal and/or retropubic tissue using a sharp tunneling instrument such as a suspension needle or a suture carrier. Because suspension needles and suture carriers include a sharp tip, there is a danger that the needle or carrier may wound large blood vessels present in the operating regions. Sharp-tipped suspension needles and suture carriers also present a risk of puncturing or otherwise injuring the bladder and/or other abdominal organs. Furthermore, the sharp end of the suspension needle or the suture carrier may cause puncture wounds to the surgeon's fingers, thus presenting a potential risk of infection to both the patient and the surgeon.
Variations of suburetheral sling and needle suspension procedures involve different approaches for accessing the surgical field. For example, some suburethral sling and needle suspension procedures involve open retropubic surgery, where the surgical field is accessed through an incision in the anterior abdominal wall followed by dissection with sharp instruments. Alternatively, the surgical field may be accessed through an incision in the anterior vaginal wall followed by dissection with sharp instruments. In some procedures, a combined abdominal and transvaginal approach is employed. Such procedures involving “blind” dissection with sharp instruments is highly invasive and may cause significant trauma to the patient.
Methods and instruments for treating female urinary incontinence that obviate the need for “blind” dissection with sharp instruments and/or the use of bone anchors, and thus, avoiding the ensuing complications, are disclosed.
A surgical instrument for treating urinary incontinence includes a handle and a curved shaft extending in a distal direction from the handle. The shaft terminates at its distal end in a blunt tip for blunt dissection of tissue. A grasping mechanism is located within a distal end portion of the shaft. The grasping mechanism can be a three-position window actuated by an actuator located on the handle, and can grasp and cut suture or sling material. The instrument is adapted to transvaginally access interior tissue within a human body, and to attach sutures or slings onto a desired attachment point. The surgical instrument can be used in conjunction with a hook-type suture deployment device. The hook-type suture deployment device is adapted to attach onto the surgical instrument and to retain a suture-carrying hook. A pair of distal flaps shields the hook from surrounding tissue during insertion of the device into the body. A pair of proximal tabs release the distal flaps so as to disengage the hook from the device, allowing the hook to engage into anchoring tissue, thereby attaching a suture onto a desired location.
It is an object of this invention to provide instruments and methods for treating female stress urinary incontinence through transvaginal access and by blunt dissection. It is another object of this invention to provide instruments and methods for deploying sutures and/or slings in a surgical procedure, with reduced risk of accidental puncturing of the surgeon's fingers or injury to the patient's bladder and/or other abdominal organs.
In one another aspect, the present invention provides surgical instruments adapted for use in procedures to treat female urinary incontinence. The instrument includes a handle and a curved shaft that extends in a distal direction from the handle. The instrument is adapted to access interior tissue within a human body, such as the pelvic cavity. In one embodiment, the handle includes a friction-based gripping surface. A blunt tip is disposed at a distal end of the shaft for blunt dissection of tissue. The shaft is curved upward to facilitate transvaginal access of the pelvic cavity. In particular, the curved shaft and blunt tip allow the instrument to be moved through the endopelvic floor via blunt dissection, and to access retropubic tissue or suture attachment points such as Cooper's ligament or rectus fascia. A grasping mechanism, for grasping and cutting sutures or slings, may be located within a distal end portion of the shaft. The grasping mechanism is adapted to release a suture or a sling from the surgical instrument at a desired retropubic location. In an alternative embodiment, a hook deployment device may be attached to the surgical instrument through the grasping mechanism.
In one embodiment, the grasping mechanism comprises a window that is adapted to be positioned in an open, an intermediate, and a closed position. An actuator located on the handle of the surgical device controls the window position. In some embodiments, the actuator includes a knob or a button located on the handle. A suture or sling may be introduced into the instrument when the window is in the open position, retained in the surgical instrument when the window is in the intermediate position, and released from the instrument when the window is placed in the closed position.
In another aspect, the present invention provides a method of treating female urinary incontinence by supporting the bladder neck with an anchorless sling. In these methods, a first end of a sling is grasped through a curved surgical instrument having a blunt tip. In one embodiment, the ends of the sling are attached to sutures, and the suture is grasped in the surgical instrument. First and second incisions are made in the anterior vaginal wall on either side of the urethra, and the surgical instrument loaded with a sling is inserted into the body through the first vaginal wall incision. Guiding the surgical instrument through the endopelvic fascia, blunt dissection of tissue is performed through the endopelvic floor without cutting or piercing tissue. Once the surgical instrument carrying the sling reaches the desired location, the cutting mechanism is actuated and the suture or the sling is cut to release the sling at the retropubic location. The process is repeated on the contralateral side of the urethra thereby treating female urinary incontinence by suburethral placement of an anchorless sling.
In one embodiment, the method of treatment comprises the steps of grasping one end of the sling or the suture by placing the window of the grasping mechanism in an open position, inserting the sling or suture into the window of the grasping mechanism, placing the window into the intermediate position, transvaginally introducing the surgical instrument into the retropubic space, deploying the sling by placing the window in the closed position, thereby cutting the sling ends or the sutures, and repeating the procedure on the opposite side of the urethra.
In an alternative embodiment, the method of treatment comprises the steps of grasping one end of the sling or the suture by placing the window of the grasping mechanism in an open position, inserting the sling or suture into the window of the grasping mechanism, placing the window into the intermediate position, transvaginally introducing the surgical instrument into the retropubic space, blunt dissecting up to the pubic symphysis, tracing the pubic symphysis, “tenting” the abdominal wall with the blunt tip of the surgical instrument, making an incision in the abdominal wall at the site of the “tented” tissue, thus creating a tunnel through the vaginal wall to the abdominal wall without performing “blind” dissection with a sharp instrument. After the tunnel has been established, a sling or suture-carrying sling may be attached to the abdominal wall and/or the rectus fascia. The procedure is then repeated on the contralateral side of the urethra, resulting in a suburethral sling or suture suspension of the urethra.
In another aspect, the present invention relates to a device for deploying a surgical implant, such as a suture-carrying surgical hook, within a human body. The deployment device comprises a body member adapted to attach or clip onto an instrument, preferably a minimally invasive surgical tool such as the surgical instrument described above. The body member includes a hemi-cylindrical-shaped connector adapted for attachment to the grasping mechanism of the surgical instrument. The hemi-cylindrical-shaped connector includes a fold line positioned along a central axis of the body member and a grasping bar. The deployment device also includes a suture hook retainer, a pair of distal flaps, and a pair of proximal tabs.
In a preferred embodiment, the distal flaps, the pair of proximal tabs pair, and the retainer are coupled to the body member along the central axis of the convex surface of the hemi-cylindrical connector. The retainer is proximal to the proximal tabs, which is proximal to the pair of distal flaps. The distal flaps releasably attaches the curved top of the hook to the deployment device and the retainer releasably attaches the proximal end of the hook to the deployment device. The proximal tabs enclose the pointed tip of the suture carrying-hook from surrounding tissue until deployment.
The proximal tabs of the pair of proximal tabs are bendable distally toward the central axis of the body. When the device is positioned at the deployment site, the surgeon applies a retrograde force to surgical instrument thereby causing the pair of proximal tabs to bend distally toward the central axis of the body member. When the pair of proximal tabs are flexed in the distal direction 1) the pointed tip of the suture-carrying hook is exposed and 2) the proximal tabs engage the distal flaps. Upon engagement of the distal flaps by the proximal tabs, the distal flaps are driven outward in a direction generally perpendicular to the central axis of the body. Thus, when the pair of proximal tabs is flexed in the distal direction, the pointed tip of the hook is exposed and the curved top of the hook is released, permitting the tip of the hook to engage surrounding tissue, and detaching the hook from the deployment device.
In another aspect, this invention provides a surgical treatment of female stress urinary incontinence that comprises anchored placement of a suburethral sling. In this method, a sling is attached to a shaft of a hook, the hook and the attached suture are placed within a hook deployment device that includes a shield for the hook. The hook deployment device is attached by a snap fit to a curved surgical instrument that includes a blunt tip. In another embodiment, the hook deployment device may be attached to the curved surgical instrument through a grasping mechanism of the surgical instrument. The instrument and the attached deployment device are transvaginally inserted into the body through a vaginal incision. The instrument is guided through endopelvic fascia via blunt dissection, without the use of sharp instruments. The suture-carrying hook is deployed in the abdominal cavity as follows. After the hook deployment site has been accessed, the surgeon positions the deployment device so that the tip of the hook faces the desired anatomical support structure. The surgeon applies a retrograde force to the surgical instrument and the hook is then released from the deployment device and anchored at a desired location within the body, for example, the Cooper's ligament or another retropubic support structure, with the suture or sling extending from the shaft of the hook. The free end of the sling is then anchored on the contralateral side of the urethra by repeating the procedure on the opposite side of the urethra.
Other aspects, features, and embodiments of the invention will become apparent from the following description including the following description of the drawings.
In the drawings, like reference characters generally refer to the same parts throughout the different figures. The drawings are not to scale, emphasis instead being placed upon illustrating the principles of the invention. Preferred and exemplary embodiments of the present invention are discussed further in the detailed description, with reference to the drawings, which show the following.
The surgical instrument 10 is adaptable to be used in conjunction with a variety of tips and a variety of suture and/or sling deployment devices, providing the surgeon the flexibility to choose between different fixation methods.
A hook-type suture deployment device 50 is illustrated in
The handle 14 is adapted for gripping with ease. In preferred embodiments, the handle is at least about 4 inches in length. The handle 14 may be made of any relatively firm material, including plastics or metals. In one embodiment, the handle 14 tapers towards the proximal 13 end, to facilitate gripping by the user, as shown in
The elongated shaft 16 extends distally from the handle 14, and comprises a curved portion 24. The shaft 16 is curved in order to facilitate a proper transvaginal insertion and manipulation of the surgical instrument 10. The shaft 16 is generally linear at its proximal end 18 and angles upward near its distal end 19. The upward angle can be from 10 to about 135 degrees. In a preferred embodiment, the upward angle is approximately 30-60 degrees. In a most preferred embodiment, the upward angle is approximately 45 degrees. The shaft 16 may be made of any of a variety of medically acceptable materials, including steel, stainless steel, aluminum, and titanium, but is preferably made of stainless steel. The shaft 16 may have a variety of cross sectional shapes, including rectangular, hexagonal, or triangular, but preferably the shaft 16 has a circular cross section. The length of the shaft 16 is consistent with transvaginal delivery of sutures or slings. In preferred embodiments, the length of the shaft 16 is within the range of from about 6 inches to about 8 inches.
The shaft 16 terminates at its distal end 19 in a blunt tip 20. In a preferred embodiment the shaft has a circular cross section and the blunt tip 20 is beveled at the distal end with rounded edges such that the blunt tip of the shaft is “duck-billed shaped.” The blunt tip 20 permits blunt dissection of tissue, rather than cutting through tissue with an instrument having sharp edges. Thus, the tissues are separated along their natural planes and damage to the traversed tissues is minimized. The blunt tip 20, together with the curved shaft 16, permit the surgeon to guide the instrument 10 from the vaginal cavity to the retropubic space so as to access the suture or sling deployment site while reducing damage to the pelvic cavity.
The grasping mechanism 22 is adapted, in a grasping mode, to grasp a suture or a sling, so that the surgical instrument 10 can deliver the suture or sling to a desired location within the body. In the cutting mode, the grasping mechanism 22 is adapted to cut the suture or sling, thereby detaching the suture or sling from the surgical instrument 10 and leaving the suture or sling at a deployment site.
In some embodiments, the grasping mechanism 22 includes a three-position window 26 operated by an actuator 28 located on the handle 14.
In one embodiment, an actuator 28, located on the handle 14 operates the three position window 26. The actuator 28 operates a moveable element 36 positioned within the window 26. When the actuator 28 is in the open position, the moveable element 36 is retracted in the proximal location and the window 26 is open (
The surgical instrument 10 as illustrated in
In preferred embodiments, the surgical procedure may be initiated by applying anesthesia to the female patient. The patient is placed in the lithotomy position and a pair of incisions is made in the anterior vaginal wall on either side of the urethra. The surgeon holds the curved surgical instrument 10 via the handle 14, the moveable element is set in the open position and a suture or sling material is inserted into the grasping mechanism through the opening 32 in the window 26. The actuator is set to place the moveable element 36 in the intermediate grasping position. The surgeon then inserts the instrument 10 through the anterior vaginal incision. The surgeon performs blunt dissection of tissue by using the blunt tip 20 of the instrument 10, and by digitally separating tissue and muscle. The deep endopelvic fascia is bluntly dissected in order to access the retropubic space. Blunt dissection thus proceeds from the vaginal incision through the vesicovaginal space, and into the retropubic space.
The surgeon completely traces the backside of the pubic symphysis with the instrument 10, guiding the instrument 10 through the rectus fascia, and accesses Cooper's ligament or another anatomical support structure. The surgeon, through tactile palpation, may identify the chosen anatomical support structure. Once the surgical instrument reaches the deployment site, the surgeon places the actuator in the closed position and the sling or suture is severed and thus released from the surgical device. The suture or sling material is thereby detached from the instrument 10, and attaches to the desired anatomical support structure.
The surgical instrument 10 can also be adapted to be used in conjunction with different types of suture deployment devices, which may be attached at the distal end 19 of the shaft 16. The surgical instrument 10 thus allows the surgeon to choose the type of sling or suture deployment procedure best suited to his patient's needs and to his own preferences.
In overview, the suture deployment device 50 comprises a body 52, a suture hook retainer 54 for retaining the suture carrying hook 56, a pair of distal flaps 86 for retaining and shielding the hook 56 from surrounding tissue during insertion of the suture deployment device 50 into the body, and a pair of proximal tabs 88 adapted to protect the tip 80 of the suture-carrying hook 56 when the device is being deployed. The proximal tabs 86 are also adapted to flex distally thus displacing the distal flaps 58 and exposing the pointed tip 80 of a suture-carrying hook 56. The hook 56 is adapted for engagement in anchoring tissue 62. The deployment device 50 may be made of any of a variety of medically acceptable materials, including plastic and/or metal, for example aluminum, titanium, or stainless steel. The dimensions of the deployment device 50 are preferably from about 2.0 cm to about 2.5 cm in length, and about 0.6 cm to about 0.9 cm in width.
The deployment device comprises a body 52 adapted to attach or clip onto an instrument, such as the curved surgical instrument 10 described above. In one embodiment, the body member includes a hemi-cylindrical-shaped connector 70 adapted for attachment to the distal section of the surgical instrument. The semi-cylindrical-shaped connector includes a central axis and aligned with a physical fold line 68. The semi-cylindrical-shaped connector may be attached to the shaft of the surgical instrument by friction fit. Optionally, the connector includes a grasping bar 69 that is adapted for engagement with the grasping mechanism of the surgical instrument. A suture hook retainer 54, a pair of distal flaps 86, and a pair of proximal tabs 88 are coupled to the body member along the central axis of the convex surface of the semi-cylindrical connector 70.
The body of the deployment device 52 comprises a retainer 54 for attaching the proximal end of the suture-carrying hook to the deployment device. The suture-carrying hook 56 includes a linear shaft 74 that has a proximal end 76 and a curved top end 78 terminating in a sharp tip 80. A suture or sling 81 is attached to the proximal end of the hook. In one embodiment, the suture or sling is threaded is an eyelet 82 formed at a proximal end 76 of the shaft 74 of the hook 56. In other embodiments, the suture or sling is integrally attached to the hook.
In an exemplary embodiment, the length of the hook 56 may be approximately 1.0-1.5 cm, and the height of the hook 56 (i.e. the perpendicular distance between the tip 80 and the linear shaft 74 may be approximately 0.2-0.5 cm. In a preferred embodiment, the height of the hook is about 0.3 cm. The hook may be made from any biologically compatible and medically acceptable material, such as titanium, aluminum, or stainless steel.
The retainer 54 is coupled to the body member 52 on the convex surface of the connector at the proximal end 66 of the body member 52. In one embodiment, the retainer comprises 54 is a snap located on the physical fold line 68 of the body 52 at the proximal end 66 of the body 52. The snap releasably holds the linear shaft 74 of the hook 56 by a friction fit.
In one embodiment, the pair of distal flaps 86 grasps and protects the curved top 78 of suture-carrying hook 56. The retainer 54 may grasp the proximal end of the suture-carrying hook 56 through, for example, friction fit. The pair of proximal tabs 88 is located adjacent to and spaced apart from the distal flaps 86 such that the pair of proximal tabs 88 contacts the distal flaps 86 when the proximal tabs 88 are flexed forward in the distal direction.
The pair of distal flaps 86 is located on the central axis of the body member 52 at the distal end 64. The pair of distal flaps 86 is adjacent to and spaced apart from the retainer 54. The shield formed by the distal flaps 86 is adapted to enclose the curved top end 78 of the hook 56. The distal flaps 86 are attached to the convex surface of the connector along the fold line 68 of the body member 52 such that one flap is positioned on each side of the fold line 68.
The proximal tabs 88 are bendable inward, toward the fold line 68 of the body 52. The proximal tabs 88 are located adjacent to and spaced apart from the distal flaps 86. The distance between the proximal tabs 88 and the distal flaps 86 is such that when the proximal tabs 88 bend inward, they engage the interior surfaces of the distal flaps 86. When the instrument is drawn in the proximal direction, the proximal tabs 88 engage the distal flaps 86. Upon engagement of the distal flaps 86 by the proximal tabs 88, the distal flaps 86 are driven outward, generally, in a direction perpendicular to the fold line 68 of the body member 52. This action exposes the hook 56. Drawing the device in the proximal direction drives the sharp tip 80 of the hook 56 into the surrounding anchoring tissue 62, and releases the hook 56 from the deployment device 50.
In operation, the surgeon attaches a suture or a sling 81 onto the proximal end 76 of a hook 56, for example through an eyelet 82 in the shaft of the hook. In alternative embodiments, the suture or sling is permanently affixed to the distal end of the hook. The shaft 74 of the hook 56 is releasably engaged by the retainer 54, and the curved top end 78 of the hook 56 is positioned within the shield formed by the distal flaps 86, which in one embodiment includes a pair of distal flaps 86 as shown in
The instrument 10 is guided through the pelvic cavity into the retropubic space. The suture attachment location is chosen so that sutures or sling 81, when attached to the location can support the bladder neck and thereby treat female stress urinary incontinence. The surgeon then manipulates the instrument 10 so as to work the deployment device 50 into a position from which the hook 56 can be released and engaged into a predetermined anatomical support structure, such as, the Cooper's ligament. While the device 50 is being worked into position, the proximal tabs 88 protect the hook 56. Finally, the surgeon releases the hook 56 from the deployment device 50, thereby anchoring the hook 56 into an anatomical support structure with the suture or sling 81 extending from the proximal end 76 of the hook. The hook 56 is released from the deployment device 50 by bending inward a pair of proximal tabs 88 to drive outward a pair of distal flaps 86, thereby exposing the hook 56 and allowing the hook 56 to engage onto anchoring tissue 62. The proximal tabs 88 and the distal flaps 86 reduce the risk of injury to abdominal organs by the sharp edges of an instrument. Sutures can thus be deployed and attached more safely and efficiently, with reduced patient morbidity.
The surgical instruments 10 are adapted to deliver a variety of sling materials through a transvaginal operation. As described above, slings enhance continence by providing a fixed or unfixed support for the bladder neck and/or the proximal urethra. Possible sling materials include organic materials such as rectus fascia, fascia lata, cadaveric fascia, or synthetic materials. Organic material such as rectus fascia and fascia lata tend to produce less scarring as compared to inorganic materials.
Having described certain preferred and exemplary embodiments of the invention, it will be apparent to those of ordinary skill in the art that other embodiments incorporating the concepts disclosed herein can be used without departing from the spirit and the scope of the invention. The described embodiments are to be considered in all respects only as illustrative and not limiting. Therefore, it is intended that the scope of the present invention be only limited by the following claims.
|Patente citada||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US2751903||22 Abr 1954||26 Jun 1956||Ivory Harry S||Adjustable retractor for surgical use|
|US2917878||13 Nov 1958||22 Dic 1959||American Cyanamid Co||Method of sterile packing|
|US3372477 *||15 Dic 1966||12 Mar 1968||Clemens B. Hoppe||Surgical suture extractor|
|US3472232||31 May 1967||14 Oct 1969||Abbott Lab||Catheter insertion device|
|US3565073||15 Abr 1968||23 Feb 1971||Constantine J Tatooles||Method and means for attaching a body appendage|
|US3699969||1 Jun 1971||24 Oct 1972||Allen William Glenn||Method for implanting natural or synthetic fibers into living tissue|
|US3704712||10 Abr 1970||5 Dic 1972||Medidyne Corp||Dilator device|
|US3710795||29 Sep 1970||16 Ene 1973||Alza Corp||Drug-delivery device with stretched, rate-controlling membrane|
|US3763860||26 Ago 1971||9 Oct 1973||H Clarke||Laparoscopy instruments and method for suturing and ligation|
|US3875937||31 May 1973||8 Abr 1975||American Cyanamid Co||Surgical dressings of absorbable polymers|
|US3877434||11 Feb 1974||15 Abr 1975||Sherwood Medical Ind Inc||Vascular tourniquet|
|US3937223||19 Abr 1974||10 Feb 1976||American Cyanamid Company||Compacted surgical hemostatic felt|
|US3995619||14 Oct 1975||7 Dic 1976||Glatzer Stephen G||Combination subcutaneous suture remover, biopsy sampler and syringe|
|US4172458||7 Nov 1977||30 Oct 1979||Pereyra Armand J||Surgical ligature carrier|
|US4363319||20 Abr 1981||14 Dic 1982||Applied Medical Devices, Inc.||Ready-to-use bandage incorporating a coagulant composition and method of preparing same|
|US4367816||10 Jun 1981||11 Ene 1983||Wilkes Kenneth R||Tear strip for gas sterilizable package and package|
|US4422567||17 Nov 1981||27 Dic 1983||Haynes Taylor H||Medical suturing device|
|US4445898||16 Mar 1982||1 May 1984||Hollister Incorporated||Fecal incontinence device with separable release sheets|
|US4535768||25 Ago 1982||20 Ago 1985||South African Inventions Development Corporation||Set of surgical instruments|
|US4583540||30 Mar 1981||22 Abr 1986||Hills Family Preservation Trust||Hair replacement apparatus|
|US4606335||20 Ago 1984||19 Ago 1986||Highland Orthopedic Center||Cerclage wire passer|
|US4739751||3 Oct 1986||26 Abr 1988||Temple University||Apparatus and method for reconstructive surgery|
|US4741330||4 Abr 1986||3 May 1988||Hayhurst John O||Method and apparatus for anchoring and manipulating cartilage|
|US4744353||18 Abr 1986||17 May 1988||Mcfarland Joseph R||Method for attaching soft tissue to bone tissue|
|US4776337||26 Jun 1986||11 Oct 1988||Expandable Grafts Partnership||Expandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graft|
|US4784137||16 Nov 1987||15 Nov 1988||Kulik Yaroslav P||Surgical suturing instrument|
|US4784138||20 Jul 1987||15 Nov 1988||Trek Medical Products, Inc.||Method for implanting retinal tack|
|US4798193||18 May 1987||17 Ene 1989||Thomas J. Fogarty||Protective sheath instrument carrier|
|US4824435||18 May 1987||25 Abr 1989||Thomas J. Fogarty||Instrument guidance system|
|US4872451||2 Feb 1987||10 Oct 1989||Moore Robert R||Glenohumeral ligament repair|
|US4873977||11 Feb 1987||17 Oct 1989||Odis L. Avant||Stapling method and apparatus for vesicle-urethral re-anastomosis following retropubic prostatectomy and other tubular anastomosis|
|US4874375||13 Abr 1987||17 Oct 1989||Ellison Arthur E||Tissue retractor|
|US4896668||9 Abr 1987||30 Ene 1990||Peters||Plate set for osteal fixation, equipped with suture strands|
|US4920958||27 Jun 1988||1 May 1990||Minnesota Mining And Manufacturing Company||Drill guide assembly|
|US4927420||14 Nov 1988||22 May 1990||Colorado Biomedical, Inc.||Ultra-sharp tungsten needle for electrosurgical knife|
|US4938760||29 Mar 1989||3 Jul 1990||American Medical Systems, Inc.||Female suspension procedure|
|US4946468||8 Dic 1989||7 Ago 1990||Mitek Surgical Products, Inc.||Suture anchor and suture anchor installation tool|
|US4983168||5 Ene 1989||8 Ene 1991||Catheter Technology Corporation||Medical layered peel away sheath and methods|
|US4988339||30 Dic 1988||29 Ene 1991||Vadher Dinesh L||Retractable needle/syringe devices for blood collection, catheterization, and medicinal injection procedures|
|US5002550||7 Feb 1990||26 Mar 1991||Mitek Surgical Products, Inc.||Suture anchor installation tool|
|US5013292||24 Feb 1989||7 May 1991||R. Laborie Medical Corporation||Surgical correction of female urinary stress incontinence and kit therefor|
|US5064435||28 Jun 1990||12 Nov 1991||Schneider (Usa) Inc.||Self-expanding prosthesis having stable axial length|
|US5078730||6 Nov 1990||7 Ene 1992||Mitek Surgical Products, Inc.||Holder for suture anchor assembly|
|US5084058||27 Jun 1990||28 Ene 1992||Mitek Surgical Products, Inc.||Suture rundown tool and cutter system|
|US5085661||29 Oct 1990||4 Feb 1992||Gerald Moss||Surgical fastener implantation device|
|US5087263||25 Abr 1990||11 Feb 1992||Mitek Surgical Products, Inc.||Suture throw holder and rundown system|
|US5089013||1 Feb 1990||18 Feb 1992||Ethicon, Inc.||Suture coated with a polyvinyl ester|
|US5112344||4 Oct 1989||12 May 1992||Petros Peter E||Surgical instrument and method of utilization of such|
|US5133723||3 Jul 1991||28 Jul 1992||Mitek Surgical Products, Inc.||Suture rundown tool and cutter system|
|US5149329||12 Dic 1990||22 Sep 1992||Wayne State University||Surgical suture carrier and method for urinary bladder neck suspension|
|US5152749||28 Jun 1991||6 Oct 1992||American Medical Systems, Inc.||Instrument placement apparatus|
|US5163946||17 Dic 1991||17 Nov 1992||Mitek Surgical Products, Inc.||Suture rundown tool and cutter system|
|US5167634||22 Ago 1991||1 Dic 1992||Datascope Investment Corp.||Peelable sheath with hub connector|
|US5188636||7 May 1992||23 Feb 1993||Ethicon, Inc.||Purse string suture instrument|
|US5203784||3 Sep 1991||20 Abr 1993||Linvatec Corporation||Bioabsorbable tack for joining bodily tissue and apparatus for deploying same|
|US5207679||22 Jun 1992||4 May 1993||Mitek Surgical Products, Inc.||Suture anchor and installation tool|
|US5222508||9 Oct 1992||29 Jun 1993||Osvaldo Contarini||Method for suturing punctures of the human body|
|US5234457||9 Oct 1991||10 Ago 1993||Boston Scientific Corporation||Impregnated stent|
|US5250033||28 Oct 1992||5 Oct 1993||Interventional Thermodynamics, Inc.||Peel-away introducer sheath having proximal fitting|
|US5256133||31 Ene 1991||26 Oct 1993||Spitz Robert M||Device for correcting stress urinary incontinence|
|US5279311||30 Jun 1993||18 Ene 1994||Linvatec Corporation||Suture shuttle device|
|US5281237||25 Sep 1992||25 Ene 1994||Gimpelson Richard J||Surgical stitching device and method of use|
|US5282812||10 Jul 1991||1 Feb 1994||Suarez Jr Luis||Clamp for use in vascular surgery|
|US5324306||28 May 1993||28 Jun 1994||Howmedica, Inc.||Hemostatic implant introducer|
|US5334185||5 Oct 1993||2 Ago 1994||Giesy Consultants, Inc.||End-to-end instrument placement apparatus|
|US5337736||30 Sep 1992||16 Ago 1994||Reddy Pratap K||Method of using a laparoscopic retractor|
|US5368595||6 Sep 1990||29 Nov 1994||United States Surgical Corporation||Implant assist apparatus|
|US5379496||27 Jul 1993||10 Ene 1995||American Cord & Webbing Co., Inc.||Cord release buckle|
|US5409469||4 Nov 1993||25 Abr 1995||Medtronic, Inc.||Introducer system having kink resistant splittable sheath|
|US5417226||9 Jun 1994||23 May 1995||Juma; Saad||Female anti-incontinence device|
|US5431173||29 May 1992||11 Jul 1995||Origin Medsystems, Inc.||Method and apparatus for body structure manipulation and dissection|
|US5437682 *||20 Jul 1993||1 Ago 1995||Ideas For Medicine, Inc.||Medical knot tying instrument and method for use thereof|
|US5439467 *||17 Jun 1993||8 Ago 1995||Vesica Medical, Inc.||Suture passer|
|US5441502||17 Feb 1993||15 Ago 1995||Mitek Surgical Products, Inc.||System and method for re-attaching soft tissue to bone|
|US5474543||17 May 1993||12 Dic 1995||Mckay; Hunter A.||Single needle apparatus and method for performing retropublic urethropexy|
|US5499991||19 Dic 1994||19 Mar 1996||Linvatec Corporation||Endoscopic needle with suture retriever|
|US5505735||10 Jun 1993||9 Abr 1996||Mitek Surgical Products, Inc.||Surgical anchor and method for using the same|
|US5536273 *||9 Dic 1993||16 Jul 1996||Lehrer; Theodor||Apparatus and method of extracorporeally applying and locking laparoscopic suture and loop ligatures|
|US5544664||16 May 1994||13 Ago 1996||Benderev; Theodore V.||Method of advancing a suture through tissue|
|US5562717||21 May 1993||8 Oct 1996||Axelgaard Manufacturing Company, Ltd.||Electrical stimulation for treatment of incontinence and other neuromuscular disorders|
|US5582188||16 May 1994||10 Dic 1996||Benderev; Theodore V.||Method of tensioning a suspended tissue mass|
|US5591163||14 Jun 1995||7 Ene 1997||Incont, Inc.||Apparatus and method for laparoscopic urethropexy|
|US5611515||5 Abr 1993||18 Mar 1997||Boston Scientic Corporation||Bladder neck suspension procedure|
|US5620012||16 May 1994||15 Abr 1997||Benderev; Theodore V.||Method of percutaneously anchoring a suture to a bone|
|US5624446||10 Ago 1994||29 Abr 1997||University Of Washington||System for repair of capsulo-labral separations|
|US5626614||22 Dic 1995||6 May 1997||Applied Medical Resources Corporation||T-anchor suturing device and method for using same|
|US5637112||19 Oct 1994||10 Jun 1997||Orthopedic Systems, Inc.||Apparatus for attaching suture to bone|
|US5643288||14 Jun 1995||1 Jul 1997||Incont, Inc.||Apparatus and method for laparoscopic urethropexy|
|US5645589||22 Ago 1994||8 Jul 1997||Li Medical Technologies, Inc.||Anchor and method for securement into a bore|
|US5647857||16 Mar 1995||15 Jul 1997||Endotex Interventional Systems, Inc.||Protective intraluminal sheath|
|US5683418||29 Abr 1994||4 Nov 1997||Mitek Surgical Products, Inc.||Wedge shaped suture anchor and method of implantation|
|US5690649||5 Dic 1995||25 Nov 1997||Li Medical Technologies, Inc.||Anchor and anchor installation tool and method|
|US5697931||14 Jun 1995||16 Dic 1997||Incont, Inc.||Apparatus and method for laparoscopic urethopexy|
|US5700266||25 Mar 1997||23 Dic 1997||The University Of Washington||System for repair of capsulo-labral separations|
|US5700286||22 Ago 1996||23 Dic 1997||Advanced Cardiovascular Systems, Inc.||Polymer film for wrapping a stent structure|
|US5702215||5 Jun 1995||30 Dic 1997||Li Medical Technologies, Inc.||Retractable fixation device|
|US5742943||19 Ago 1996||28 Abr 1998||Johnson & Johnson Medical, Inc.||Slip-coated elastomeric flexible articles and their method of manufacture|
|US5749884||23 Nov 1994||12 May 1998||Boston Scientific Technology, Inc.||Bone anchor implantation device and method|
|US5766221||9 Feb 1995||16 Jun 1998||Boston Scientific Technology, Inc.||Bone anchor implantation device|
|US5776184||9 Oct 1996||7 Jul 1998||Medtronic, Inc.||Intravasoular stent and method|
|US5813408||15 Sep 1995||29 Sep 1998||Boston Scientific Technology, Inc.||Surgical drape|
|US5814072||15 Nov 1996||29 Sep 1998||Bonutti; Peter M.||Method and apparatus for use in anchoring a suture|
|US5816258||13 Jun 1996||6 Oct 1998||General Surgical Innovations, Inc.||Bladder neck suspension method|
|US5836314 *||6 Jun 1996||17 Nov 1998||Boston Scientific Technology, Inc.||Surgical treatment of stress urinary incontinence|
|US6254620 *||6 Feb 1998||3 Jul 2001||Karl Storz Gmbh & Co. Kg||Surgical thread cutter|
|US6936054 *||22 Jul 2002||30 Ago 2005||Boston Scientific Scimed, Inc.||Placing sutures|
|US6991635 *||1 Oct 2002||31 Ene 2006||Nipro Corporation||Intracardiac suture device|
|US20030018350 *||16 Oct 2001||23 Ene 2003||Zucherman James F.||Curved dilator and method|
|US20030181926 *||19 Dic 2002||25 Sep 2003||Michael Dana||Suture trimmer|
|US20040176802 *||24 Mar 2004||9 Sep 2004||Orthopaedic Biosystems Ltd., Inc., A Delaware Corporation||Method and apparatus for suturing|
|US20050021055 *||9 Jun 2004||27 Ene 2005||Souhail Toubia||Surgical closure instrument and methods|
|US20050131393 *||14 Ago 2003||16 Jun 2005||Scimed Life Systems, Inc.||Systems, methods and devices relating to delivery of medical implants|
|US20050203562 *||9 Mar 2004||15 Sep 2005||Palmer Joetta R.||Lighted dissector and method for use|
|US20050222601 *||5 Abr 2005||6 Oct 2005||Martin Erhard||Laparoscopic instrument|
|PL437063A2 *||Título no disponible|
|1||*||"A Modified Percutaneous Outpatient Bladder Neck Suspension System" by Theodore V. Benderev, Dec. 1994, The Journal of Urology.|
|2||Bayer et al. A New Approach to Primary Strengthening of Colostomy with Marlex Mesh to Prevent Paracolostomy Hernia. Surgery, Gynecology & Obstretrics. 163:579-80 (1986).|
|3||Benderev: A Modified Percutaneous Outpatient Bladder Neck Suspension System, J. Urology 152: 2316-2320 (1994).|
|4||Benderev: A New Endoscopic Bladder Neck Suspension for the Outpatient Treatment of Stress Urinary Incontinence, (video v-40) J. Urology 149: 197A (1993).|
|5||Benderev: Anchor Fixation And Other Modifications Of Endoscopic Bladder Neck Suspension, Urology 40: 409-418 (1992).|
|6||Delorme, E. La bandelette trans-obturatrice: un procede mini-invasif pour traiter l'incontinence urinaire d'effort de la femme. Progres en Urologie. 11:1306-13 (2001) (English translation provided).|
|7||European Search Report dated Sep. 29, 2006 from corresponding Application No. EP 05 02 5122.|
|8||Giesy et al. Ureteral Instrumentation: A New System for Continued Access Via a Safety Guidewire. Journal of Urology. No. 4, Part 2, p. 282A (1988).|
|9||Gittes et al. No-Incision Pubovaginal Suspension for Stress Incontinence. Journal of Urology. 138:3, 568-70 (1987).|
|10||Haab et al. Feasibility of Outpatient Percutaneous Bladder Neck Suspension Under Local Anesthesia. Urology. 50:4, 585-897 (1997).|
|11||Jacquetin, B. Utilisation du TVT dans la chirurgie de l'incontinence urinaire feminine. J. Gynecol Obstet Biol Reprod. 29, 242-47 (2000).|
|12||Kovac et al. Pubic Bone Suburethral Stabilization Sling for Recurrent Urinary Incontinence. Obstetrics & Gynecology, 89:4, 624-27 (1997).|
|13||Leach et al,: Modified Pereyra Bladder Neck Suspension After Previously Failed Anti-Incontinence Surgery: Surgical Technique and Results with Long-Term Follow-Up, Urology 23: 359-362 (1984).|
|14||Mattox et al.: Modification of the Miya Hook in Vaginal Colpopexy, The Journal of Reproductive Medicine, 40: 681-683 (Oct. 1995).|
|15||Mitchell: Hook Needle and Retractor for Posterior Urethroplasty, J. Urology 42: 599-600 (1970).|
|16||Nativ et al.: Bladder Neck Suspension Using Bone Anchors for the Treatment of Female Stress Incontinence, ASAIO Journal, 204-208 (1997).|
|17||Norris et al. Use of Synthetic Material in Sling Surgery: A Minimally Invasive Approach. Journal of Endourology. 10:3, 227-30 (1996).|
|18||Pereyra: A Simplified Surgical Procedure for the Correction of Stress Incontinence in Women, West J. Surg. Obstetrics and Gynecology: 223-226 (1959).|
|19||Petros et al. An Integral Theory and Its Method for the Diagnosis and Management of Female Urinary Incontinenece. Scandinavian Journal of Urology and Nephrology. Supplement 153, 1-93 (1993).|
|20||Petros et al. Urethral Pressure Increase on Effort Originates from Within the Urethra, and Continence From Musculovaginal Closure. Neurourology and Urodynamics. 14:4, 337-50 (1995).|
|21||Petros, P. Ambulatory surgery for urinary incontinence and vaginal prolapse. Medical Journal of Australia. 161:171-72 (1994).|
|22||Petros, P. An Integral Theory of Bladder Neck Opening, Closure and Urinary Incontinence in the Female. International Journal of Gynecology & Obstetrics. XXIII World Congress of Gynaecology and Obstetrics (FIGO) 1991.|
|23||Petros, P. Medium-term Follow-up of the Intravaginal Slingplasty Operation Indicates Minimal Deterioration of Urinary Continence with Time. Aust NZ J Obstet Gynaecol. 39:3, 354-56 (1999).|
|24||Petros, P. The Intravaginal Slingpasty Operation, a Minimally Invasive Technique for Cure of Urinary Incontinence in the Female. Aust. NZ J Obstet Gynaecol. 36:4, 453-61 (1996).|
|25||Raz et al. Fascial Sling to Correct Male Neurogenic Sphincter Incompetence: The McGuire/Raz Approach. Journal of Urology. 139:528-31 (1988).|
|26||Raz et al. Vaginal Wall Sling. The Journal of Urology. 141:43-6 (1989).|
|27||Raz, S. Modified Bladder Neck Suspension for Female Stress Incontinence. Urology. 17:1, 82-5 (1981).|
|28||Schaeffer et al.: Endoscopic Suspension of Vesical Neck for Urinary Incontinence, Urology 23: 484-494 (1984).|
|29||Stamey, T.A. Endoscopic Suspension of the Vesical Neck for Urinary Incontinence in Females. Annals of Surgery. 192:4, 465-71 (1980).|
|30||Stamey, T.A. Endoscopic Suspension of the Vesical Neck for Urinary Incontinence. Surgery, Gynecology & Obstetrics. 136:4, 547-54 (1973).|
|31||Stamey, T.A. Endoscopic Suspension of the Vesical Neck. Stanton, Tanagho (eds.). Surgery of Female Incontinence. Springer-Verlag, Berlin; 115-32 (1986).|
|32||Staskin et al. The Gore-tex sling procedure for female sphincteric Incontinence: Indications, technique, and results. World J of Urol. 15:5, 295-99 (1997).|
|33||Staskin, D.R. Sling Surgery for the Treatment of Female Stress Incontinence. 5:1, 106-22 (1991).|
|34||Sussman, et al. The Raz Bladder Neck Suspension: Five-Year Experience. The Journal of Urology. 145, 223A (1993).|
|35||Ulmsten et al. A Multicenter Study of Tension-Free Vaginal Tape (TVT) for Surgical Treatment of Stress Urinary Incontinence. Int Urogynecol J. 9:4, 210-13 (1998).|
|36||Ulmsten et al. A Three-Year Follow Up of Tension Fee Vaginal Tape for Surgical Treatment of Female Stress Urinary Incontinence. British Journal of Obstetrics and Gynaecology. 106, 345-50 (1999).|
|37||Ulmsten et al. An Ambulatory Surgical Procedure Under Local Anesthesia for Treatment of Female Urinary Incontinence. The International Urogynecology Journal. 7:81-86 (1996).|
|38||Ulmsten et al. Connective Tissue Factors in the Aetiology of Femal Pelvic Disorders. Ann. Med. 22:6, 3 (1990).|
|39||Ulmsten et al. Intravaginal Slingplasty (IVS): An Ambulatory Surgical Procedure for Treatment of Female Urinary Incontinence. Scand J Urol Nephrol 29:1, 75-82 (1995).|
|40||Ulmsten et al. Intravaginal slingplasty. Zentralbl Gynakol. 116, 398-404 (1994).|
|41||Ulmsten et al. Surgery for female urinary incontinence. Current Opinion in Obstetrics & Gynecology. 4:3, 456-62 (1992).|
|42||Ulmsten, U. An Introduction to Tension-Free Vaginal Tape (TVT)-A New Surgical Procedure for Treatment of Female Urinary Incontinence. Int Urogynecol J. (Suppl 2): S3-4 (2001).|
|43||Ulmsten, U. The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence. Der Urologe [A] 40:269-73 (2001).|
|Patente citante||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US8128554||14 Jun 2011||6 Mar 2012||Coloplast A/S||System for introducing a pelvic implant|
|US8167785||1 May 2012||Coloplast A/S||Urethral support system|
|US8182412||17 Jun 2011||22 May 2012||Coloplast A/S||Pelvic implant with fibrous anchor|
|US8182413||22 May 2012||Coloplast A/S||Method for fibrous anchoring of a pelvic support|
|US8215310||10 Jul 2012||Coloplast A/S||Implant for treatment of vaginal and/or uterine prolapse|
|US8469877||27 Ene 2012||25 Jun 2013||Coloplast A/S||System for introducing a pelvic implant|
|US8480558||6 Nov 2007||9 Jul 2013||Caldera Medical, Inc.||Implants and procedures for treatment of pelvic floor disorders|
|US8668635||23 Feb 2012||11 Mar 2014||Coloplast A/S||Pelvic implant with suspending system|
|US8709471||6 Oct 2008||29 Abr 2014||Coloplast A/S||Medicament delivery device and a method of medicament delivery|
|US8758220||5 Ene 2010||24 Jun 2014||Caldera Medical, Inc.||Implants and procedures for supporting anatomical structures for treating conditions such as pelvic organ prolapse|
|US8852075||12 Jun 2011||7 Oct 2014||Coloplast A/S||Pelvic implant systems and methods with expandable anchors|
|US8888678||12 Jun 2011||18 Nov 2014||Coloplast A/S||Pelvic implant with suspending system|
|US8951185||18 May 2009||10 Feb 2015||Ams Research Corporation||Surgical articles and methods for treating pelvic conditions|
|US9039721||7 Nov 2011||26 May 2015||C.R. Bard, Inc.||Instruments for delivering transfascial sutures and methods of transfascial suturing|
|US9060838||20 Abr 2012||23 Jun 2015||Coloplast A/S||Tissue supported implantable device|
|US9084664||21 May 2007||21 Jul 2015||Ams Research Corporation||Method and articles for treatment of stress urinary incontinence|
|US9089394||10 Ene 2014||28 Jul 2015||Coloplast A/S||Pelvic implant with suspending system|
|US9089396 *||14 Ago 2013||28 Jul 2015||Coloplast A/S||Urinary incontinence treatment and devices|
|US20050131391 *||14 Ago 2003||16 Jun 2005||Scimed Life Systems, Inc.||Systems, methods and devices relating to delivery of medical implants|
|US20100198002 *||5 Ago 2010||O'donnell Pat D||Surgical instrument for treating female urinary stress incontinence|
|US20140039244 *||14 Ago 2013||6 Feb 2014||Coloplast A/S||Urinary incontinence treatment and devices|
|Clasificación de EE.UU.||606/148, 606/150, 606/144|
|Clasificación internacional||A61B17/00, A61B17/04, A61B17/06, A61B17/28|
|Clasificación cooperativa||A61B17/06109, A61B17/0469, A61B17/0483, A61B2017/06085, A61B2017/2904, A61B2017/00805|
|Clasificación europea||A61B17/04H, A61B17/04E, A61B17/06N12|
|24 Feb 2003||AS||Assignment|
Owner name: SCIMED LIFE SYSTEMS, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:RIOUX, ROBERT F.;REEL/FRAME:013780/0365
Effective date: 20030123
|6 Nov 2006||AS||Assignment|
Owner name: BOSTON SCIENTIFIC SCIMED, INC.,MINNESOTA
Free format text: CHANGE OF NAME;ASSIGNOR:SCIMED LIFE SYSTEMS, INC.;REEL/FRAME:018505/0868
Effective date: 20050101
|28 Sep 2012||FPAY||Fee payment|
Year of fee payment: 4